Bottom Line:
The patient had multiple risk factors with asbestos exposure and prior therapeutic radiation.However, there are other non-asbestos etiologies.Small bowel obstruction often is a late-presenting symptom of widespread tumor burden.

Affiliation: Department of Surgery, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA.

ABSTRACT

Background: Peritoneal mesothelioma is a rare malignancy that affects the serosal surfaces of the peritoneum. The peritoneum is the second most common site of mesothelium affected following the pleura. The aggressive nature and vague presentation pose many obstacles in not only diagnosis but also the treatment of patients with this disease.

Case report: We present a case of a 76-year-old woman who presented with small bowel obstruction secondary to carcinomatosis secondary to primary peritoneal mesothelioma. The patient had multiple risk factors with asbestos exposure and prior therapeutic radiation.

Conclusions: We discuss the highly varied and elusive presentation of peritoneal mesothelioma. Cumulative asbestos exposure, either directly or indirectly, remains the leading cause of mesothelioma. However, there are other non-asbestos etiologies. Small bowel obstruction often is a late-presenting symptom of widespread tumor burden. A concise review of the current diagnostic and surgical treatment of primary peritoneal mesothelioma demonstrates that early diagnosis and implementation remains vital.

Mentions:
Persistence of the small bowel obstruction was secondary to multiple areas of carcinomatosis and peritoneal metastasis. This was managed conservatively without major surgical debulking. During the laparotomy, an excisional biopsy was performed of the pelvic soft tissue and omentum (Figure 6). Final pathologic examination supported the diagnosis of primary epithelioid-type mesothelioma (Figure 7). Following the diagnosis the patient refused treatment and opted for palliative care.

Mentions:
Persistence of the small bowel obstruction was secondary to multiple areas of carcinomatosis and peritoneal metastasis. This was managed conservatively without major surgical debulking. During the laparotomy, an excisional biopsy was performed of the pelvic soft tissue and omentum (Figure 6). Final pathologic examination supported the diagnosis of primary epithelioid-type mesothelioma (Figure 7). Following the diagnosis the patient refused treatment and opted for palliative care.

Bottom Line:
The patient had multiple risk factors with asbestos exposure and prior therapeutic radiation.However, there are other non-asbestos etiologies.Small bowel obstruction often is a late-presenting symptom of widespread tumor burden.

Affiliation:
Department of Surgery, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA.

ABSTRACT

Background: Peritoneal mesothelioma is a rare malignancy that affects the serosal surfaces of the peritoneum. The peritoneum is the second most common site of mesothelium affected following the pleura. The aggressive nature and vague presentation pose many obstacles in not only diagnosis but also the treatment of patients with this disease.

Case report: We present a case of a 76-year-old woman who presented with small bowel obstruction secondary to carcinomatosis secondary to primary peritoneal mesothelioma. The patient had multiple risk factors with asbestos exposure and prior therapeutic radiation.

Conclusions: We discuss the highly varied and elusive presentation of peritoneal mesothelioma. Cumulative asbestos exposure, either directly or indirectly, remains the leading cause of mesothelioma. However, there are other non-asbestos etiologies. Small bowel obstruction often is a late-presenting symptom of widespread tumor burden. A concise review of the current diagnostic and surgical treatment of primary peritoneal mesothelioma demonstrates that early diagnosis and implementation remains vital.